NPIMap

Organization Active NPI

Gateway Behavioral Health Services

  • Psychologist
  • Woodbine, GA
National Provider Identifier
1063545762
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
GATEWAY BEHAVIORAL HEALTH SERVICES
Practice address
210 East 15TH Street
Woodbine, GA 31569
Phone
(912) 576-5075
Fax
(912) 576-3543
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Parks, CPA CFO
Title
Chief Financial Officer
Phone
(912) 554-8464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

210 East 15TH Street
Woodbine, GA 31569

Mailing address

700 Coastal Village Dr
Brunswick, GA 31520-1974
Phone (912) 554-8510

Other identifiers 1

IdentifierTypeStateIssuer
000622553ATMedicaidGA

Other names 1

  • Gateway BHS - Camden TC Comp Other name

National Provider Directory

National Provider Directory
Tax ID family
Gateway Community Service Board72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1063545762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 COASTAL VILLAGE DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315201974",
            "telephone_number": "912-554-8510",
            "fax_number": "912-264-5965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 EAST 15TH STREET",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "31569",
            "telephone_number": "912-576-5075",
            "fax_number": "912-576-3543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "912-554-8464",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA CFO"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000622553AT",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway BHS - Camden TC Comp",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woodbine, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.